The transition to Medicare is a wonderful opportunity to enjoy health care benefits when you are 65 and older, or have a disability or medical conditions that provide you with coverage when you are under the age of 65. To help you learn more about this program and prepare for enrollment, here are five positive facts about Original Medicare that you may enjoy discovering.
You Can Access Original Medicare Healthcare Benefits Throughout the United States and Its Territories
If you have Original Medicare, medical coverage is available in all 50 states and the District of Columbia in the U.S., and in its inhabited territories, including American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. In the event you require medical care while traveling, it’s important to know that most doctors and hospitals accept Original Medicare within these areas. If you’re outside of the United States, you may not get the same coverage. Original Medicare typically doesn’t cover any medical treatment you receive while outside of the United States, except under the following circumstances:
- You require emergency medical care in Canada while you are traveling a direct route between Alaska and another contiguous state, and the closest medical center is in Canada.
- You board a cruise ship and require medical care while you are in U.S. territorial waters. This includes the ship docking in a U.S. port or being within six hours of arrival or departure from a U.S. port.
- You require non-emergency medical inpatient services in a foreign hospital, and the nearest foreign hospital is closer to your residence than the nearest U.S. hospital.
In these instances, Original Medicare may cover your medical care outside of the United States. Make sure you have this information handy before traveling abroad.
You Do Not Need Referrals for Covered Services Under Original Medicare
One of the biggest benefits that comes with Original Medicare coverage is that there is no need for referrals. Since Original Medicare encompasses Part A hospital coverage and Part B outpatient/medical coverage, beneficiaries can select any doctor that accepts Medicare for their treatment needs. Therefore, under your Original Medicare plan, you’re free to select the doctors and specialists you consult with at the hospital or healthcare facility of your choice for your medical needs. As long as the selected practitioner accepts Medicare, you’re good to go.
Beneficiaries Can Select and Change Medicare Benefits Every Year
There are two annual periods when Medicare beneficiaries can change their benefits: the Annual Enrollment Period (AEP) and the Open Enrollment Period (OEP). During the AEP, which runs from October 15th to December 7th, Medicare beneficiaries can:
- Change from Original Medicare to a Medicare Advantage plan
- Change from a Medicare Advantage plan to Original Medicare
- Change from one Medicare Advantage plan to another
- Enroll in Part D prescription drug coverage
- Change from one Part D prescription drug plan to another
- Cancel their current Part D coverage
Any changes made during AEP will take effect on January 1st of the next calendar year.
OEP, on the other hand, is a little bit different. The Medicare Advantage Open Enrollment Period, which applies to those currently enrolled in a Medicare Advantage plan, runs from January 1st through March 31st. During the OEP, Medicare beneficiaries can:
- Enroll in a new Medicare Advantage plan (with or without Part D prescription drug coverage)
- Disenroll from a Medicare Advantage plan and return to Original Medicare and enroll in a stand-alone Part D prescription drug plan
Medicare Allows Coverage Adjustments When Major Life Events Occur
In addition to AEP and OEP, Medicare also includes a Special Enrollment Period (SEP) that allows beneficiaries to delay initial enrollment in Parts B and D without incurring a late enrollment penalty (LEP) or change coverage outside of designated enrollment periods without incurring penalties or gaps in coverage. Special circumstances that allow for SEP include:
- Loss of employer coverage
- Moving out of your Medicare plan’s service area
- Residing or moving in/out of a skilled nursing facility
- Losing or gaining eligibility for Medicaid coverage
In these situations, an SEP grants delayed enrollment without penalty or Medicare coverage changes to assist beneficiaries in enrolling and managing their Medicare benefits. Documentation of said circumstances is required to create the Special Enrollment Period. It is highly recommended that you verify your eligibility for an SEP.
Medicare Can Be Less Expensive Than Previous Healthcare Coverage
You Could Save Money by Enrolling in Medicare If You Are Working Past 65 for a Large Employer (Over 20 Employees)
Medicare costs, premiums, deductibles, copays and coinsurance can oftentimes be less than many employers anticipate. It is important to carefully compare your current plan premiums, deductibles and maximum out-of-pocket costs to get an accurate assessment of both options.
For most, Medicare Part A is premium-free due to paying taxes while working. However, Part B requires a monthly premium; this cost can increase with your income. Understanding the Part B surcharge, known as Income Related Monthly Adjustment Amount (IRMAA), is important since added costs up to $450 per month.
For out-of-pocket costs, Medicare Part B has a very low deductible of $226 for 2023, and the coinsurance after this is just 20% for the Medicare beneficiary. However, it is important to note that Medicare Parts A and B do not have an out-of-pocket maximum limit, so considering a Medicare supplement plan can be helpful in covering your exposure to claims. Even without an out-of-pocket maximum, Medicare is still a cost-effective choice that can offer beneficiaries savings when compared to large employer-sponsored heath coverage plans.
If you need individualized assistance with your transition to Medicare or to a different plan such as Medicare Advantage or Part D prescription coverage, you’re in the right place. Contact Medicare Portal today for one-on-one help exploring suitable plan options – schedule a virtual, phone or in-person consultation with one of our licensed Medicare insurance agents today.